摘要
目的探讨超声心动图冠状动脉测值联合C反应蛋白(CRP)、红细胞沉降率(ESR)与小儿不完全性川崎病(IKD)合并冠状动脉损伤(CAL)的关系。方法回顾性选取淮北市妇幼保健院2020年1月至2024年4月收治的68例IKD患儿作为IKD组,按照2∶1配对原则选择同期34例健康体检儿童作为对照组。比较两组超声心动图Z值[左冠状动脉(LCA)-Z、右冠状动脉(RCA)-Z、左前降支(LAD)-Z、左回旋支(LCX)-Z]及CRP、ESR水平,比较IKD有、无CAL患儿的一般资料,应用多因素Logistic回归筛选IKD合并CAL的危险因素,应用受试者工作特征(ROC)曲线分析各指标对IKD合并CAL的预测价值。结果IKD组LCA-Z、RCA-Z、LAD-Z、LCX-Z值及CRP、ESR水平高于对照组[3.26±0.97比1.35±0.28、3.46±0.92比1.01±0.29、3.18±0.69比1.18±0.34、2.97±0.68比1.27±0.34、(39.97±9.03)mg/L比(4.21±1.05)mg/L、(59.67±16.34)mm/1 h比(12.85±2.43)mm/1 h],差异有统计学意义(P<0.05)。IKD有、无合并CAL患儿发热持续时间、静脉注射免疫球蛋白(IVIG)治疗反应应答率、IVIG开始使用时间<10 d率及肌酸激酶(CK)、肌酸激酶同工酶-MB(CK-MB)、N末端B型钠尿肽前体(NT-proBNP)水平比较差异有统计学意义[(10.02±2.45)d比(7.68±1.43)d、65.22%(15/23)比88.89%(40/45)、60.87%(14/23)比86.67%(39/45)、(236.78±59.74)U/L比(192.67±35.41)U/L、(45.19±9.85)U/L比(33.18±9.87)U/L、(1.78±0.32)μg/L比(0.92±0.20)μg/L](P<0.05)。Logistic回归分析结果显示,发热持续时间、IVIG治疗反应、IVIG开始使用时间、CK、CK-MB、NT-proBNP、超声心动图Z值、CRP、ESR水平是IKD合并CAL的独立危险因素(P<0.05)。ROC曲线分析结果表明,LCA-Z、RCA-Z、LAD-Z、LCX-Z、CRP、ESR联合预测IKD合并CAL的曲线下面积最大,为0.917(95%CI 0.824~0.970),高于各指标单独诊断(P<0.05)。结论IKD患儿超声心动图Z值及CRP、ESR水平与患儿是否合并CAL存在一定关系,可用于辅助评估IKD合并CAL。
Objective To explore the relationship between coronary artery measurements combined with C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and coronary artery lesionsin(CAL)with incomplete Kawasaki disease(IKD)in children.Methods Sixty-eight cases of pediatric IKD admitted to Huaibei Maternal and Child Health Care Hospital from January 2020 to April 2024 were selected as the IKD group,and 34 healthy children undergoing physical examination during the same period were selected as the control group according to the principle of 2∶1 pairing.Echocardiographic Z values including left coronary artery(LCA)-Z,right coronary artery(RCA)-Z,left anterior descending branch(LAD)-Z,left circumflex branch(LCX)-Z and CRP,ESR were compared between the two groups.General information of children with or without CAL were compared.The multivariate Logistic regression was used to screen the risk factors of IKD combined with CAL,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index to IKD combined with CAL.Results The LCA-Z,RCA-Z,LAD-Z,LCX-Z and the levels of CRP,ESR in the IKD group were higher than those in the control group:3.26±0.97 vs.1.35±0.28,3.46±0.92 vs.1.01±0.29,3.18±0.69 vs.1.18±0.34,2.97±0.68 vs.1.27±0.34,(39.97±9.03)mg/L vs.(4.21±1.05)mg/L,(59.67±16.34)mm/1 h vs.(12.85±2.43)mm/1 h,there were statistical differences(P<0.05).The duration of fever,intravenous immunoglobulin(IVIG)treatment response,IVIG start time,creatine kinase(CK),creatine kinase-MB(CK-MB),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)between the children with IKD and CAL,IKD without CAL:(10.02±2.45)d vs.(7.68±1.43)d,65.22%(15/23)vs.88.89%(40/45),60.87%(14/23)vs.86.67%(39/45),(236.78±59.74)U/L vs.(192.67±35.41)U/L,(45.19±9.85)U/L vs.(33.18±9.87)U/L,(1.78±0.32)μg/L vs.(0.92±0.20)μg/L,there were statistical differences(P<0.05).Logistic regression analysis showed that the duration of fever,IVIG treatment response,IVIG initiation time,CK,CK-MB,NT-proBNP,echocardiographic Z value,CRP and ESR levels were independent risk factors for IKD combined with CAL(P<0.05).ROC curve analysis results showed that the area under the curve of IKD combined with CAL predicted by LCA-Z,RCA-Z,LADE-Z,LCX-Z,CRP and ESR was the largest,which was 0.917(95%CI 0.824-0.970),which was higher than that diagnosed by each index alone(P<0.05).Conclusions There is a certain relationship between the echocardiographic Z values,CRP and ESR in children with IKD and CAL,which can be used to assist in the evaluation of IKD complicated with CAL.
作者
姜大质
朱建常
陈鹏
刘爽
Jiang Dazhi;Zhu Jianchang;Chen Peng;Liu Shuang(Department of Ultrasound,Huaibei Maternal and Child Health Care Hospital,Huaibei 235000,China)
出处
《中国医师进修杂志》
2025年第6期564-569,共6页
Chinese Journal of Postgraduates of Medicine
关键词
超声心动图
C反应蛋白质
红细胞沉降率
不完全性川崎病
病情
Echocardiography
C-reactive protein
Erythrocyte sedimentation rate
Incomplete Kawasaki disease
State of illness
